ORAL HABITS
HABIT: DEFINITIONS
Dorland: Fixed or constant
practice established by frequent repetition.
Buttersworth : Frequent or constant
practice or acquired tendency, which has been fixed by frequent repetition.
Moyer: Habits are learnt pattern of
muscle contraction of a very complex nature.
CLASSIFICATIONSOBSESSIVE
(DEEP ROOTED)
INTENTIONAL MASOCHISTIC (MEANINGFUL) (SELF
INFLICTING)
NAIL BITING GINGIVAL STRIPPINGLIP BITINGDIGIT SUCKING
NON OBSESSIVE(EASILY LEARNED & DROPPED)
UNINTENTIONAL FUNCTIONAL
ABNORMAL PILLOWING TONGUE THRUSTINGCHIN PROPPING BRUXISM
CLASSIFICATION
James (1923)/ GraberUsefulHarmful
KingsleyFunctional
oral habitMuscular
habitcombined
Finn (1987) Compulsive Non
compulsive Primary
habit Secondary
habit
Klein (1977)Emptymeaningful
THUMB SUCKING DEFINITION:
According to Gellin “It is placement of thumb or one or more finger in varying depth into the mouth”.
THEORIES:
1. PSYCHOANALYTICAL/PSYCHOSEXUAL THEORY:-
by SIGMUND FREUD in 1928. According to which thumb sucking habit evolves from an inherent psychosexual drive where child derives pleasure during thumb sucking.
2. ORAL DRIVE THEORY:- Formulated by SEARS AND WISE 1982. According to this theory prolongation of
nursing strengthen the oral drive & child begins thumb sucking.
INTRA ORAL: Maxillary anterior
proclination Mandibular anterior
retroclination Anterior open bite Constricted intercanine
area‐70% Constriction of maxillary
arch Posterior cross bite
EXTRA ORAL: • Fungal infection on
thumb • Thumb nail exhibit dish
pan appearance. • Upper Lip: short,
hypotonic• Jaw: maxillary protrusion,
mandibular retrusion• Palate: high vault• Nasal floor : narrow• Profile: straight
CLINICAL FEATURES
MANAGEMENT Starts 4 to 6 years 4 different approaches1. Counselling2. Reminder therapy3. Reward system4. Adjunctive therapy
1. COUNSELLING • Explain about habits ill effects• Show photographs, video• Dunlop hypothesis• Discuss with parents
2. REMINDER THERAPY “Wants to stop but needs help”
- Adhesive waterproof bandage- Sock to cover fingers- Paint bitter substances- Acrylic guard or guaze- Removable or fixed appliances
REMOVABLE APPLIANCES :passive appliances which are retained in the oral cavity by means of clasp & usually have of the following additional components:-
1. Tongue spikes 2.Tongue Guard 3. Spur/rake
FIXED APPLIANCES :
1. Quad helix 2. Hay rakes
Habit crib applianceQuad helix
3. Maxillary lingual arch with palatal crib
3. ADJUNCTIVE THERAPY
Wrapping the patient’s arm with elastic bandage Intra oral Palatal crib: Patient without crossbite Retainer 6‐12 months
TONGUE THRUSTING
According to Norton and Gellin "a condition in which the tongue protrudes between the anterior or posterior teeth during swallowing with or without affecting tooth position .”
DEFINITION:
CLASSIFICATION:
“According To MOYER”
A. Normal swallow: (a) Infantile swallow (b) Adult swallow
B. Simple tongue thrust
C. Complex tongue thrust
D. Retained infantile swallow
“According To BACKLUND”
1. Anterior tongue thrust2. Posterior tongue
thrust
Retained infantile swallow Upper respiratory tract infections Neurological disturbances Functional adaptability to transient change
in anatomy Feeding practices and tongue thrusting Induced due to other oral habits Hereditary Tongue size –ex: macroglossia
CLINICAL MANIFESTATIONS Lip‐ short flaccid upper lip Mandibular movements‐ no correlation
between tongue tip and mandible Speech‐ s,n,t,d,l,z, v,th Facial form‐ Increased in anterior facial
height
ETIOLOGY
CLINICAL FEATURESOpen Bite (Anterior and Posterior)Proclination of upper anterior teethProtrusion of anterior segment of both arches with spaces between incisors & caninesNarrow & constricted maxillary arch: Posterior cross bite
DIAGNOSIS: History Examination water test checking contractions of the muscle: Temporalis muscle lower lip
TREATMENT CONSIDERATIONS: Age Presence/absence of associated
manifestations Malocclusion Speech defects Associated with other habits
TREATMENT: Training of correct swallow and posture of
tongue Speech therapy Mechanotherapy Correction of malocclusion Surgical treatment
TRAINING OF CORRECT SWALLOW AND POSTURE OF TONGUE
MYOFUNCTIONAL EXERCISES 40times per day in 2‐3sessions sugarless fruit drop –twice daily 4s exercise other exercises Using appliances as a guide in the correct
positioning of tongue Pre orthodontic Trainer Nance palatal Arch Appliance
SPEECH THERAPY Not before 8 years
MECHANOTHERAPY Removable Appliance Therapy Fixed Habit Breaking Appliance Oral screen
MOUTH BREATHING DEFINITION:
Sassouni (1971) defined Mouth breathing as habitual respiration through the mouth instead of the nose.
CLASSIFICATION: “Given by Finn 1987”
(1) Anatomic : Mouth breather is one whose short upper lip does not permit complete closure without undue effort
(2) Habitual : Persistence of habit even after the elimination of obstructive cause
(3) Obstructive : Increased resistance to complete obstruction of normal airflow to nasal passage
ETIOLOGY: Developmental Anomalies like abnormal
development of nasal cavities . Partial obstruction in deviated nasal
septum and Localized benign tumor. Infection inflammation of nasal mucosa as:- Chronic allergic, chronic atrophic Rhinitis,
Enlarged adenoid tonsils. Traumatic injures of nasal cavity Genetic Pattern
CLINICAL FEATURES: Facial appearance : Adenoid facies. Long narrow face, narrow nose and nasal
passage. Short upper lip. Nose tipped superiorly Expressionless face. DENTAL EFFECT (INTRA ORAL) Protrusion of maxillary incisors Palatal vault is high. Increase incidence of caries. Chronic marginal gingivitis.
DIAGNOSIS : History
Examination CLINICAL TESTS Mirror test Butterfly test Water Holding test inductive plethysmography. Cephalometrics
EXAMINATION:(i) Observe the patient unknowingly while at rest
In a nasal breather – lip touch lightly In mouth breather – Lip are kept apart.
(ii) Patient asked to take deep breath Nasal breather keep the lip tightly closed Mouth breather take deep breath keeping mouth open.
CLINICAL TEST:
Mirror test: Double side mirror is held b/w the nose and
mouth fogging on the nasal side of mirror indicate nasal breathing while fogging toward the oral side indicate oral breathing.
Water test: The patient is asked to fill the mouth with
water,and hold it for a period of time. While nasal breather accomplish with ease, mouth breather find the task difficult.
Cotton test: A butterfly shaped piece of cotton is placed
over the upper lip below the nostril. If cotton flutters down it indicate nasal breathing.
MANAGEMENT: 1) SYMPTOMATIC TREATMENT: The gingiva of the mouth breathers should be
restored to normal health by coating the gingiva with petroleum jelly.
2) ELIMINATION OF THE CAUSE:If nasal or pharyngeal obstruction has been diagnosed then removal of the cause is done by surgery .
3) INTERCEPTION OF THE HABIT : a) Physical Exercise b) Lip Exercise 4) ORAL SCREEN: An effective device during sleeping hours, is a
thin rubber membrane either cut or cast to fit over the labial and buccal surfaces of the teeth and gums included in the vestibule of the mouth. During initial phase, windows are placed on the oral screen so as not to completely block the airway passage. 5)CORRECTION OF
MALOCCLUSION 1) Children with class I skeletal and occlusion and anterior spacing- oral shield appliance. 2)class II division without crowding,age5-9 years-Monobloc activator. 3)classIII malocclusion-interceptive methods are reccommended as a chin cap.
BRUXISMDEFINITION:Ramfjord 1966Bruxism is habitual griding of teeth when the individual is not chewing or swallowing.
CLASSIFICATION:1. Day Time Bruxism/Diurnal Bruxism2. Night Time Bruxism/Nocturnal Bruxism
OCCURRENCE:May commence in infancy with the eruption of the first primary tooth.Common occurrence is during sleepIncidence of bruxismin children varies widely from 7% to 88%.
ETIOLOGY:
(1) CNS: This CNS phenomena was found in children with cerebral palsy & mental retardation.
(2) Psychological: A tendency of grind teeth associated with feeling of hunger and aggression, hate,anxiety etc.
(3) Occlusal discrepancy : Improper interdigitation of teeth lead to bruxism.
(4) Systemic factor : Mg++ deficiency may lead to bruxism.
(5) Genetic. (6) Occupation: Overenthusiastic student or
competitive sports lead to clenching .
.
CLINICAL FEATURES :(1) Occlusal trauma(2) Pain in TMJ(3) Trauma to periodontium. (4) Masticatory muscle soreness. (5) Headache. MANAGEMENT:- (6) ADJUNCTIVE THERAPY:-
Psychotherapy- Aim to lower the emotional disturbances.
Relining exercise - Serve to decrease muscle function
Elimination of oral pain & discomfort by giving ethyl chloride within the tempromandibular joint area
Auto suggestion and Hypnosis: Wherethe patient becomes conscious of his habit and understands the possible consequence
(2) OCCLUSAL THERAPY:
Occlusal adjustments:Biteraising crowns,splintsand elimination of occlusal interference
Bite plates and splints
Occlusal reconstruction and prosthesis
Bite guard: Preventscontinual abrasion of teeth
LIP HABITS
DEFINITION:Habit involve manipulation of lips and perioral structure are termed as lip habits.
ETIOLOGY :•Malocclusion •Habit•Emotional Stress
CLASSIFICATION:- Wetting the Lip with the tongue. Pulling the lip into mouth between the
teeth.
CLINICAL FEATURES: Protrusion of upper anteriors & retrusion of lower anteriors. Lip trap Muscular imbalance Lower incisor collapse with lingual crowding Mentolabial sulcus become accentutated.
TREATMENT: Lip Protector Lip bumper –it is used as a adjustive
therapy in both comprehensive and interceptive treatment . It is positioned in mandibular vestibule and serve to prohibit the lip from exerting excessive force on mandibular incisor and reposition the lip away from lingual aspect of maxillary incisors.
Visual education
NAIL BITING HABITS It is most common habit in children It is sign of internal tension
ETIOLOGY: Persistence nail bitting may be indicative of
emotional problem. Psychosomatic Successor of thumb sucking.
CLINICAL FEATURES: Crowding Rotation. Alteration of incisal edge of incisor Inflammation of nail bed.
MANAGEMENT: Patient is made aware of problem. Treat the basic emotional factor
causing the act. Encouraging outdoor activity which
may help in easing tension. Application of nail polish, light cotton
mittens as reminder.
CONCLUSION:The identification and assessment of an abnormal habits and its immediate and long term effect on the craniofacial complex and dentition should be made as early as possible to minimize the potential deleterious effect on dentofacial Complex.
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